Takayasu's arteritis
Takayasu's arteritis affects the aorta (the very large main artery that exits the heart
and receives all of the blood to be delivered throughout the body), and arteries which
branch off of the aorta. Initial symptoms include fatigue, fever, sweating at night, joint
pain, and loss of appetite and weight. Every organ may be affected by this disease. A
common sign of this disease is the inability to feel the pulse in any of the usual
locations (the pulse is the regular, rhythmic sensation one can feel with a finger over an
artery, for example in the wrist, which represents the beating of the heart and the
regular flow of blood).
Symptoms of Takayasu's arteritis
The symptoms of Takayasu's arteritis vary depending on the
stage of the illness and the arteries affected. Early symptoms tend to be nonspecific and
can include fever, fatigue, poor appetite, weight loss, night sweats, joint pain and chest
pain. Later symptoms typically are related to arterial narrowing and a decrease in blood
flow to specific organs. These later symptoms can include:
- Symptoms of poor blood flow to the kidneys, especially hypertension and renal failure
- Weak or absent pulses in the arms, neck or legs
- A significant difference in blood pressure between the right and left arms
- A significant difference in blood pressure between the arms and legs
- Angina (chest pains, especially with exertion)
- Symptoms of congestive heart failure
- Symptoms of poor blood flow to the brain, such as transient ischemic attacks, fainting,
dizziness, changes in vision or symptoms of stroke
- Symptoms of poor blood flow to the abdominal organs, including abdominal pain, nausea
and vomiting
- Claudication (muscle weakness and pain triggered by limb movement) of the arms or legs
Diagnosis of Takayasu's arteritis
Because patients with early Takayasu's arteritis may have nonspecific
symptoms and because the disease is so rare, a doctor may not suspect Takayasu's arteritis
until symptoms of arterial narrowing develop. This could be months, or even years, into
the course of the illness. In fact, a recent review of Takayasu's arteritis patients at
one U.S. hospital showed that only 6 percent were diagnosed correctly when they were
evaluated initially.
For your doctor, the earliest clue to the diagnosis may be the unexplained
appearance of hypertension, difficulty obtaining a blood pressure measurement on one side,
a difference in blood pressure reading between the two arms or symptoms of poor
circulation — all unusual findings in a young person
Your doctor may suspect that you have Takayasu's arteritis if you have at
least three of the six criteria developed by the American College of Rheumatology to
distinguish it from other forms of vasculitis:
- Symptoms beginning at age 40 or younger
- Claudication affecting the arms or legs
- A decreased pulse in the brachial artery (major artery in the upper arm)
- A bruit (a sign of turbulent blood flow, heard with a stethoscope) in your aorta or
subclavian artery
- An abnormal angiogram showing signs of aortic or arterial damage
- At least a 10-mm Hg (millimeters of mercury) difference in the systolic blood pressure
(the first number in your blood pressure reading) between your right and left arms
To confirm the diagnosis, your doctor will review your symptoms and
medical history, then perform a thorough physical examination with special attention to
your heart and blood vessels. He or she will measure the blood pressure in your arms and
legs and assess the strength of pulses in your extremities and neck. To check for bruits
in narrowed vessels, your doctor will use a stethoscope to listen to specific areas of
your chest, neck and abdomen.
After the physical examination, your doctor may order blood tests,
including a complete blood count and erythrocyte sedimentation rate. Also, to identify
specific areas of arterial damage, your doctor may request one or more of the following
studies: standard angiography, magnetic resonance angiography, Doppler ultrasound,
standard magnetic resonance imaging (MRI) or computed tomography (CT).
Treatment of Takayasu's arteritis
Treatment of Takayasu arteritis is difficult, but results with
appropriate therapy are encouraging. Early detection is important. Steroids and
immunosuppressive agents form the cornerstone of treatment, with surgery reserved for
complications caused by narrowed arteries.
Surgery to bypass narrowed arteries may be necessary to supply blood beyond the
constriction. |
